Gipsies and drug addictions. Study of the adherence to treatment

FRANÇAIS :
Le but de la recherche est de comparer la rétention dans un programme de maintenance à la naltrexone (PMN) entre une population gitane et une population "gadgio" (non-gitane) de la province d'Alava (Pays Basque). L'hypothèse est que le facteur de risque "gitan" n'est pas différent du facteur "gadgio" pour la continuation du traitement aux antagonistes d'opiacés. Basée sur une étude rétrospective de follow-up, 2 cohortes ont été étudiées en fonction de leur appartenance ethnique. La cohorte gitane était constituée de 52 personnes auxquelles on a apparié 52 personnes non-gitanes, qui ont constitué la deuxième cohorte. Les variables d'appariement étaient l'âge, le sexe, le soutien familial et le statut de VIH+. Après une période de désintoxication, tous les sujets ont participé au PMN et on a évalué la rétention à ce programme. Il y avait une plus grande probabilité de continuation pour le groupe non-gitan même s'il n'y avait que des tendances plutôt que des différences significatives. Les mesures de prévention et d'information doivent tenter de toucher l'idiosyncrasie de la culture gitane. (Résumé d'auteur)
ENGLISH :
Aims: To compare the retention in a Naltrexone Maintenance Programme (NMP) between a gipsy and a 'paya' (non-gipsy) population in the province of Alava (Basque Country, Spain). Hypothesis: The exposure factor' to be a gipsy' is no different from the factor' to be "payo" (non-gipsy)' with regard to the response in the continuation of treatment with opiate antagonists. Design and Participants: Based on a retrospective follow-up study, two cohorts were considered based on the ethnic group to which one belonged. The cohort of gipsies was made up of 52 cases, for whom by means of a matching process 52 'payo' (non-gipsy) subjects were selected to form the other cohort. The matching variables were age, sex, the family support, and HIV+ status. After a period of detoxifi- cation, all the subjects participated in a NMP and the retention in this programme was evaluated. Findings: The survival analysis showed a continuation probability that was higher for the non-gipsy group than for the gipsy group, even though the differences were not significant but they did show a tendency (p < 0.06). The posthoc tests showed differences between the continuations shown by both cohorts between 4 and 8 weeks, with this not being observed at other times. A subsequent proportional risks regression analysis showed a strong influence of the previous treatments variable, the effect of which was greater in the gipsy group, with this finally causing a correction in the continuation curves that reduced the differences. Conclusions: The results are dis- cussed with regard to the context of the gipsy ethnical group, and suggestions are made with regard to the need for establishing preventive and informative measures that manage to reach the idiosyncrasy of the gipsy culture. (Author's abstract.)